Full Name *
National ID / Passport Number *
Alternative Phone Number
Phone Number *
Date of Birth
Email Address *
Business / Trading Name *
Business Registration Number
Business District *
Village
Chief Name
GPS Coordinates
Physical Address (Directions) *
Subject Choose...Get financingBecome an agentOther
Merchant / Agent Number
M-Pesa / EcoCash Number
Bank Name
Branch
Account Name
Account Number
Reference Name
Relationship
Phone Number
Email
Have you ever been convicted of fraud, theft, or financial crime? NOYES
[message]
Upload the following documents:
Certified Copy of National ID / Passport
Proof of Address
Company Registration Document
Company Tax Clearance Certificate
